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Estimated comparative daily doses for inhaled glucocorticoids in adolescents ≥12 years and adults

Estimated comparative daily doses for inhaled glucocorticoids in adolescents ≥12 years and adults
Drug Low dose
(total daily dose)		 Medium dose
(total daily dose)		 High dose
(total daily dose)*

Beclomethasone HFA
(Qvar RediHaler product available in United States)

Administer as 2 divided doses

 80 to 160 mcg >160 to 320 mcg >320 to 640 mcg
40 mcg per actuation 2 or 4 inhalations
80 mcg per actuation 2 inhalations 4 inhalations 6 or 8 inhalations

Beclomethasone HFAΔ
(Qvar product available in Canada, Europe, and elsewhere)

Administer as 2 divided doses

 100 to 200 mcg >200 to 400 mcg >400 to 800 mcg
50 mcg per actuation 2 to 4 inhalations
100 mcg per actuation 2 inhalations 4 inhalations 6 or 8 inhalations

Budesonide DPI
(Pulmicort Flexhaler product available in United States)

Administer as 2 divided doses

 180 to 360 mcg >360 to 720 mcg >720 to 1440 mcg
90 mcg per actuation 2 or 4 inhalations
180 mcg per actuation 2 inhalations 4 inhalations 6 or 8 inhalations

Budesonide DPIΔ
(Pulmicort Turbuhaler or Turbohaler product available in Canada, Europe, and elsewhere)

Administer low doses (ie, ≤400 mcg/day) once daily; administer higher doses (ie, >400 mcg/day) as 2 to 4 divided doses

 200 to 400 mcg >400 to 800 mcg >800 to 2400 mcg
100 mcg per actuation 2 to 4 inhalations
200 mcg per actuation 1 to 2 inhalations 3 to 4 inhalations
400 mcg per actuation 1 inhalation 2 inhalations 3 to 6 inhalations

Ciclesonide HFA
(Alvesco product available in United States, Europe, and elsewhere)

United States: Administer as 2 divided doses

Australia, Europe, and elsewhere: Administer lower doses (ie, 160 to 320 mcg/day) once daily; administer 640 mcg dose as 2 divided doses

 160 mcg 320 mcg 640 mcg
80 mcg per actuation 2 inhalations 4 inhalations
160 mcg per actuation ◊ 2 inhalations 4 inhalations

Ciclesonide HFAΔ
(Alvesco product available in Canada)

Administer lower doses (eg, 100 to 400 mcg) once daily; administer 800 mcg dose as 2 divided doses

 100 to 200 mcg >200 to 400 mcg >400 to 800 mcg
100 mcg per actuation 1 to 2 inhalations 3 to 4 inhalations
200 mcg per actuation 1 inhalation 2 inhalations 3 to 4 inhalations

Fluticasone propionate HFA
(Flovent HFA product available in United States)

Administer as 2 divided doses

 176 to 220 mcg >220 to 440 mcg >440 to 1760 mcg
44 mcg per actuation 4 inhalations
110 mcg per actuation 2 inhalations 4 inhalations
220 mcg per actuation ◊ 2 inhalations 4 to 8 inhalations

Fluticasone propionate HFAΔ
(Flovent HFA product available in Canada; Flixotide Evohaler product available in Europe and elsewhere)

Administer as 2 divided doses

 100 to 250 mcg >250 to 500 mcg >500 to 2000 mcg
50 mcg per actuation 2 to 4 inhalations
125 mcg per actuation 2 inhalations 4 inhalations
250 mcg per actuation ◊ 2 inhalations 4 to 8 inhalations

Fluticasone propionate DPI
(Flovent Diskus product available in United States and Canada; Flixotide Accuhaler product available in Europe and elsewhere)

Administer as 2 divided doses

 100 to 250 mcg >250 to 500 mcg >500 to 2000 mcg
50 mcg per actuation 2 to 4 inhalations
100 mcg per actuation 2 inhalations 4 inhalations
250 mcg per actuation ◊ 2 inhalations 4 to 8 inhalations
500 mcg per actuation (strength not available in United States) ◊ ◊ 2 or 4 inhalations

Fluticasone propionate DPI
(Armonair Digihaler product available in United States; Aermony Respiclick product available in Canada)

Administer as 2 divided doses

 110 mcg 226 mcg 464 mcg
55 mcg per actuation 2 inhalations
113 mcg per actuation ◊ 2 inhalations
232 mcg per actuation ◊ ◊ 2 inhalations

Fluticasone furoate DPI
(Arnuity Ellipta product available in United States, Canada, Australia, and elsewhere, but not available in Europe or UK)

Administer once daily

NOTE: Inhaled fluticasone furoate has a greater anti-inflammatory potency per microgram than fluticasone propionate inhalers. Thus, fluticasone furoate is administered at a lower daily dose and used only once daily.

 50 mcg (by use of pediatric DPI, which is off-label in adolescents and adults) 100 mcg 200 mcg
50 mcg per actuation 1 inhalation
100 mcg per actuation ◊ 1 inhalation 2 inhalations
200 mcg per actuation ◊ ◊ 1 inhalation

Mometasone DPI
(Asmanex Twisthaler product available in United States)

May administer lower doses (ie, 220 to 440 mcg/day) once daily; administer 880 mcg dose as 2 divided doses

 220 mcg >220 to 440 mcg >440 to 880 mcg
110 mcg per actuation 2 inhalations
220 mcg per actuation 1 inhalation 2 inhalations 4 inhalations

Mometasone HFA
(Asmanex HFA product available in United States)

Administer as 2 divided doses

 200 mcg >200 to 400 mcg >400 to 800 mcg
100 mcg per actuation 2 inhalations 4 inhalations
200 mcg per actuation ◊ 2 inhalations 4 inhalations

Mometasone DPIΔ
(Asmanex Twisthaler product available in Canada, Europe, and elsewhere)

May administer lower doses (ie, 200 to 400 mcg/day) once daily; administer 800 mcg dose as 2 divided doses

 200 mcg >200 to 400 mcg >400 to 800 mcg
200 mcg per actuation 1 inhalation 2 inhalations
400 mcg per actuation ◊ 1 inhalation 2 inhalations
  • The most important determinant of appropriate dosing is the clinician's judgment of the patient's response to therapy. The clinician must monitor the patient's response on several clinical parameters and adjust the dose accordingly. The stepwise approach to therapy emphasizes that once control of asthma is achieved, the dose of medication should be carefully titrated to the minimum dose required to maintain control, thus reducing the potential for adverse effects.
  • Suggested total daily doses for low, medium, and high dose inhaled glucocorticoid regimens are based on daily doses recommended by Global Initiative for Asthma (GINA), National Asthma Education and Prevention Program (NAEPP), and/or product labeling[1-5]. This is not a table of equivalence.
  • Depending on the specific product, total daily doses are administered once or divided and given twice daily. Refer to local product information or a clinical drug reference (eg, Lexicomp).
  • Some doses are outside the approved product information recommendations.

DPI: dry powder inhaler; HFA: hydrofluoroalkane propellant metered dose inhaler.

* Evidence for additional improvement with dose increases >1000 mcg/day is limited.

¶ Select alternate preparation with higher mcg/actuation to improve convenience.

Δ Products shaded in light gray color are not available in the United States but are available widely elsewhere.

◊ Select preparation with fewer mcg/actuation.
Data from:
  1. Global Initiative for Asthma (GINA); Global Strategy for Asthma Management and Prevention; 2021. Available at www.ginasthma.org.
  2. National Heart, Blood, and Lung Institute Expert Panel Report 3 (EPR 3): Guidelines for the Diagnosis and Management of Asthma; 2007. NIH Publication 08-4051 available at http://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines/full-report and pro.
  3. US Food & Drug Administration (FDA) approved product information. US National Library of Medicine. (Available online at www.dailymed.nlm.nih.gov/dailymed/index.cfm.)
  4. Health Canada-approved product monograph. Health Canada. (Available online at https://health-products.canada.ca/dpd-bdpp/index-eng.jsp.)
  5. European Medicines Agency (EMA) summary of product characteristics. European Medicines Agency. (Available online at www.ema.europa.eu/en/medicines.)
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